Clinical Support Specialist
OneShare Health
On-site
Irving, Texas, United States
Administration, Operations & Management
OneShare Health, LLC., based in Irving Texas is a medical cost sharing ministry providing a unique and affordable, ACA-exempt path to healthcare. Our core value is the biblical imperative of giving to and serving others. With industry-leading membership programs and an unparalleled member experience, OneShare Health is passionate about finding ways to fulfill our ministry to members, staff, and other charitable organizations.
As a condition of employment, each employee will be required to affirm that he or she will be able to carry out all employment duties in a way that supports and is consistent with OneShare Health's Christian mission, vision, scriptural foundation, values, and beliefs found on our website at About Our Christian Health Care Sharing Ministry | OneShare Health
Job purpose
The Clinical Support Specialist is responsible for delivering an unmatched member experience through excellence in purpose-driven, customer service. This critical role serves to provide telephonic-based, case-management services by identifying resources, proactively engaging and assisting members, and providers with pre notification, steerage, post service assistance, and records correspondence.
Areas of Accountability / Main Activities/ Expected Results:
Area No. 1: Customer Service
Main Activities:
Provides high-touch support, program education, and steerage for members.
Coordinates care, tracks, and reports on members over the course of treatment.
Provides individualized customer service based on unique customer needs.
Demonstrates effective, active listening to collect relevant information, build rapport and respond to callers in a professional and compassionate manner with accurate information.
Accurately and expediently resolves issues, finds solutions, and provides information to OneShare Health members and providers.
Continually meets and exceeds Quality Assurance call audit standards.
Performs administrative functions relative to the clinical support team (I.E.- IB/OB calls, post service calls, managing pre notification inbox with handling and uploading records to phi, requesting appropriate records for case review, managing cases from start to finish.).
Area No. 2: Operational Processes and Procedures
Main Activities:
Continually utilizes scripts and other reference materials along with internal systems and processes to provide excellent customer service and one-call resolution.
Accurately documents all provider and member interactions in a timely manner and in accordance with internal policies and procedures.
Ensures compliance with all federal and state laws, rules and regulations and CVS policy and procedures at all times.
Communicates effectively with customers/patients while protecting their confidential health and medication information according to HIPAA and relevant state laws.
Area No. 3: Cross-Functional Collaboration
Main Activities:
Manages client crises with support of clinical team.
Consults with clinical operations team on treatment options and member needs.
Effectively and proactively collaborates with cross-functional team members.
Education / Certification(s) / Experience / Skills(s)
High School Diploma/GED required and/or equivalent experience.
One (1) Plus years of inbound call center, customer service experience.
Two (2) Plus years of experience in case management or care navigation/coordination.
Familiarity with databases (Illumifin) preferred but not required.
Familiarity with Salesforce preferred but not required.
Bi-lingual (English/Spanish) strongly preferred.
Demonstrated ability to effectively multitask.
Demonstrated understanding of medical terminology.
Demonstrated attention to detail and accuracy in a fast-paced environment.
Proficiency in various Microsoft applications.
Excellence in verbal and written communication skills.
Work Environment
Typically exposed to routine office noises such as printers, phones, and work interruptions via email, instant messaging, telephone and in-person.
Physical Demands
Prolonged periods sitting at a desk and working on a computer.
EEO Statement
OneShare Health, LLC is an equal opportunity employer and does not discriminate on the basis of race, color, religion, creed, sex, national origin, age, disability, pregnancy status, sexual orientation, gender identity, veteran status, marital status, genetic information, citizenship status, or other status protected by law. In compliance with the Immigration Reform and Control Act of 1986, we will hire only U.S. citizens and aliens lawfully authorized to work in the United States
As a condition of employment, each employee will be required to affirm that he or she will be able to carry out all employment duties in a way that supports and is consistent with OneShare Health's Christian mission, vision, scriptural foundation, values, and beliefs found on our website at About Our Christian Health Care Sharing Ministry | OneShare Health
Job purpose
The Clinical Support Specialist is responsible for delivering an unmatched member experience through excellence in purpose-driven, customer service. This critical role serves to provide telephonic-based, case-management services by identifying resources, proactively engaging and assisting members, and providers with pre notification, steerage, post service assistance, and records correspondence.
Areas of Accountability / Main Activities/ Expected Results:
Area No. 1: Customer Service
Main Activities:
Provides high-touch support, program education, and steerage for members.
Coordinates care, tracks, and reports on members over the course of treatment.
Provides individualized customer service based on unique customer needs.
Demonstrates effective, active listening to collect relevant information, build rapport and respond to callers in a professional and compassionate manner with accurate information.
Accurately and expediently resolves issues, finds solutions, and provides information to OneShare Health members and providers.
Continually meets and exceeds Quality Assurance call audit standards.
Performs administrative functions relative to the clinical support team (I.E.- IB/OB calls, post service calls, managing pre notification inbox with handling and uploading records to phi, requesting appropriate records for case review, managing cases from start to finish.).
Area No. 2: Operational Processes and Procedures
Main Activities:
Continually utilizes scripts and other reference materials along with internal systems and processes to provide excellent customer service and one-call resolution.
Accurately documents all provider and member interactions in a timely manner and in accordance with internal policies and procedures.
Ensures compliance with all federal and state laws, rules and regulations and CVS policy and procedures at all times.
Communicates effectively with customers/patients while protecting their confidential health and medication information according to HIPAA and relevant state laws.
Area No. 3: Cross-Functional Collaboration
Main Activities:
Manages client crises with support of clinical team.
Consults with clinical operations team on treatment options and member needs.
Effectively and proactively collaborates with cross-functional team members.
Education / Certification(s) / Experience / Skills(s)
High School Diploma/GED required and/or equivalent experience.
One (1) Plus years of inbound call center, customer service experience.
Two (2) Plus years of experience in case management or care navigation/coordination.
Familiarity with databases (Illumifin) preferred but not required.
Familiarity with Salesforce preferred but not required.
Bi-lingual (English/Spanish) strongly preferred.
Demonstrated ability to effectively multitask.
Demonstrated understanding of medical terminology.
Demonstrated attention to detail and accuracy in a fast-paced environment.
Proficiency in various Microsoft applications.
Excellence in verbal and written communication skills.
Work Environment
Typically exposed to routine office noises such as printers, phones, and work interruptions via email, instant messaging, telephone and in-person.
Physical Demands
Prolonged periods sitting at a desk and working on a computer.
EEO Statement
OneShare Health, LLC is an equal opportunity employer and does not discriminate on the basis of race, color, religion, creed, sex, national origin, age, disability, pregnancy status, sexual orientation, gender identity, veteran status, marital status, genetic information, citizenship status, or other status protected by law. In compliance with the Immigration Reform and Control Act of 1986, we will hire only U.S. citizens and aliens lawfully authorized to work in the United States